Bullous pemphigoid and chronic kidney graft rejection

Lopez, Frederick; Losa, Adoración Martinez; Guillén, Paloma Sánchez‐Pedreño; Ishii, Norito; Hashimoto, Takashi; García, P. Martínez

doi:10.1111/jdv.14396

Cited by 4 publications

(10 citation statements)

References 8 publications

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“…Among them, most were chronic rejection, with only four cases having acute rejection ( 36 , 37 , 51 , 54 ). Mucosal involvement has been observed in two patients ( 48 , 52 ). One patient developed pemphigoid disease with autoantibodies to both laminin γ1 and γ2 subunits during renal transplant rejection ( 42 ).…”

Section: Resultsmentioning

confidence: 98%

Pemphigoid diseases in patients with end-stage kidney diseases: pathogenesis and treatment

Yang,

Wang,

Zuo

2024

Front. Immunol.

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BackgroundPemphigoid diseases constitute a group of autoimmune blistering disorders characterized by subepithelial blistering. The association between pemphigoid diseases and both end-stage kidney disease (ESKD) and its treatment is notable. However, there is limited evidence about the management of pemphigoid diseases in patients with ESKD. This systematic review compiled case reports and relevant studies, summarized the underlying mechanisms of pemphigoid diseases in patients with ESKD, and summarized the efficacy of various therapies.MethodsA systematic search of PubMed and Embase was performed for articles published between 1982 to June 2, 2024.ResultsFifty-three case reports and eight relevant studies were included. Triggers for pemphigoids in patients with ESKD included materials used to treat ESKD, immune dysregulation of patients with ESKD, and rejection of renal allograft. Treatment for these patients included removing triggers, as well as administering of corticosteroids, mycophenolate mofetil (MMF), tetracyclines, rituximab, methotrexate, dapsone, azathioprine, cyclosporine, intravenous immunoglobin (IVIG), plasmapheresis, and Janus kinase inhibitors.ConclusionRemoving triggers is the most effective strategy. Despite their suboptimal efficacy, corticosteroids remain the most commonly used agents in this patient population. MMF, tetracyclines, and rituximab are less used but with benefits. There are significant adverse effects associated with methotrexate treatment. Other treatment may also be beneficial and require further investigation. These findings may enable clinicians to optimize the therapeutic approach for these patients.

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Section: Resultsmentioning

confidence: 98%

Pemphigoid diseases in patients with end-stage kidney diseases: pathogenesis and treatment

Yang,

Wang,

Zuo

2024

Front. Immunol.

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“…Although adolescent onset pemphigoid is rare, 28 there have been several reports of pemphigoid following bone marrow or organ transplantation. [29][30][31][32] It is thought that a strong immune response to the allograft leads to cross-reactivity with the skin and other organs, inducing autoimmunity at a relatively early age. On the other hand, three patients with low titres of anti-α6β4 integrin antibodies also had autoantibodies to BP180, suggesting that epitope spreading may have occurred.…”

Section: Discussionmentioning

confidence: 99%

“…The patient with high levels of anti‐α6β4 integrin antibodies was an adolescent after organ transplantation. Although adolescent onset pemphigoid is rare, 28 there have been several reports of pemphigoid following bone marrow or organ transplantation 29–32 . It is thought that a strong immune response to the allograft leads to cross‐reactivity with the skin and other organs, inducing autoimmunity at a relatively early age.…”

Section: Discussionmentioning

confidence: 99%

Anti‐α6β4 integrin autoantibodies inhibit the binding of laminins to α6β4 integrin in patients with pemphigoid and affect the gastrointestinal tract

Arase,

Sasaoka,

Narita

et al. 2023

Acad Dermatol Venereol

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BackgroundAnti‐α6β4 integrin autoantibodies can be observed in some patients with mucous membrane pemphigoid. We have previously identified anti‐α6β4 integrin extracellular domain autoantibodies together with anti‐BP180 NC16A antibodies in a patient with DPP‐4 inhibitor‐induced bullous pemphigoid. However, the significance and impact of anti‐α6β4 integrin antibodies are unknown.ObjectivesTo characterize anti‐α6β4 integrin extracellular domain autoantibodies in pemphigoid patients, to determine whether these antibodies inhibit laminin‐α6β4 integrin binding and to observe their systemic effects.MethodsAnti‐α6β4 integrin autoantibodies were analyzed by staining cells expressing the extracellular region of α6β4 integrin with sera from 20 patients with pemphigoid. The anti‐α6β4 integrin autoantibodies were characterized using different transfectants. The binding of laminins to α6β4 integrin was studied using cells expressing the activated conformation of α6β4 integrin and the inhibitory effect of the autoantibodies on the binding of laminins to α6β4 integrin was tested. Trends in antibody titers and clinical symptoms were quantified and analyzed.ResultsIgG autoantibodies against the extracellular domain of anti‐α6β4 integrin were found in some patients with pemphigoid. Laminin binding to α6β4 integrin was observed in the active conformation of α6β4 integrin, and serum from a patient with a high titer of anti‐α6β4 integrin antibodies inhibited the binding of both laminin‐511 and laminin‐332 to α6β4 integrin. α6β4 integrin is expressed on the basement membrane of both skin and small intestine, and exfoliation was observed in the patient's epidermis and small intestinal epithelium. A reduction in the titer of the anti‐α6β4 integrin antibody was associated with improvement in both skin and gastrointestinal symptoms.ConclusionsThis study demonstrated the presence of anti‐α6β4 integrin extracellular domain‐specific autoantibodies in some patients with pemphigoid. In addition, these autoantibodies showed inhibitory activity on α6β4 integrin‐laminin binding. Anti‐α6β4 integrin antibodies can affect the gastrointestinal tract as well as the skin and oral mucosa.

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“…5 However, these skin cancer clinics also insisted on primary prevention through encouraging sunprotective behaviours and chemoprevention. 4,6 Although such clinics have been remarkably effective at detecting and treating incident keratinocyte cancers, the efficacies of primary prevention and chemoprophylaxis implementation in reducing the disease burden are not well established. The aim of the study was to investigate whether SOTRdedicated skin cancer clinics decrease the disease burden in the long term, in terms of the trend in keratinocyte RL and PS contributed equally to this work.…”

Section: Acknowledgementmentioning

confidence: 99%

“…It is hypothesised that the immunological activity of the graft induces the formation of autoantibodies which would attack antigens of the BMZ with cross-reactivity. 6 Cross-reactivity between self and graft antigens might be explained through a phenomenon of molecular mimicry, epitopespreading or the same target structure shared in kidney and the skin. 7 This hypothesis was supported by the deposition of C3 and IgG on the glomerular BMZ and spontaneous clearance of blisters after transplantectomy or graft atrophy.…”

Section: Letters To the Editors E81mentioning

confidence: 99%

Bullous pemphigoid in kidney transplant rejection: A case report and literature review

Bao

Wang

et al. 2021

Aust J Dermatology

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We found that overall 0.7% of patients were positive to this allergen with a relevance rate of 45%. However, internationally positivity rates are decreasing; falling from 0.78% from 1980 to 2009 to just 0.03% from 2010 to 2018 at a tertiary patch test centre in the United Kingdom. 9 We found 31 positive and eleven relevant reactions to dodecyl gallate. Dodecyl gallate, the ester of dodecanol and gallic acid, is an antioxidant and preservative in foods and cosmetics. In our patients, reactions were caused by cosmetics, handling cooking oils and margarine and ingested food. Gallates are often excluded from baseline series because of difficulty ascertaining relevance. However, gallate reactions may be rising and our results suggest that ongoing surveillance is needed and future consideration of inclusion in the ABS if local data confirm increased positivity and relevance rates. 10 Several ABS allergens are not included in our local baseline series. This is a limitation of our study as they were not tested in consecutive patients as the local standard series used over the study period differ from the ABS. For example, methylisothiazolinone was positive in 13.5% of patients tested, but only 1.3% of all patients presenting for patch testing overall because only 155 patients were tested to MI.In conclusion, we report the performance of ABS allergens in detecting positive and relevant reactions in a population undergoing patch testing in Sydney. The ABS detected 72.9% of relevant reactions. Missed allergens included fragrances and dodecyl gallate. The two clinics at Darlinghurst and Westmead have since adopted the ABS and unified their supplementary allergen series.

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Bullous pemphigoid and chronic kidney graft rejection

Cited by 4 publications

References 8 publications

Pemphigoid diseases in patients with end-stage kidney diseases: pathogenesis and treatment

Pemphigoid diseases in patients with end-stage kidney diseases: pathogenesis and treatment

Anti‐α6β4 integrin autoantibodies inhibit the binding of laminins to α6β4 integrin in patients with pemphigoid and affect the gastrointestinal tract

Bullous pemphigoid in kidney transplant rejection: A case report and literature review

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